Goyet et al. Implementation Science (2015) 10:32 DOI 10.1186/s13012-015-0217-1 Implementation Science RESEARCH Open Access Gaps between research and public health priorities in low income countries: evidence from a systematic literature review focused on Cambodia Sophie Goyet1*, Socheat Touch2, Por Ir3, Sovannchhorvin SamAn2, Thomas Fassier4, Roger Frutos5,6, Arnaud Tarantola1 and Hubert Barennes1,7,8 Abstract Background: Evidence-based public health requires that research provides policymakers with reliable and accessible information reflecting the disease threats. We described the scientific production of research in Cambodia and assessed to what extent it provides appropriate insights and implications for practice to guide health policymakers and managers and knowledge relevant for translation. Methods: We conducted a systematic review of scientific articles published on biomedical research in Cambodia. Regression analysis assessed the trends over time and factors associated with actionable messages in the articles’ abstracts. Results: From 2000 to 2012, 628 articles were published in 237 journals with a significant increase over time (from 0.6/million population to 5.9/million population, slope coefficient 7.6, 95% CI 6.5–8.7, p < 0.001). Most publications on diseases addressed communicable diseases (n = 410, 65.3%). Non-communicable diseases (NCD) were under-addressed (7.7% of all publications) considering their burden (34.5% of the disease burden). Of all articles, 67.8% reported descriptive studies and 4.3% reported studies with a high level of evidence; 27.4% of studies were led by an institution based in Cambodia. Factors associated with an actionable message (n = 73, 26.6%) were maternal health (OR 3.08, 95% CI 1.55–6.13, p = 0.001), the first author’s institution being Cambodian (OR 1.78, 95% CI 1.06–2.98, p = 0.02) and a free access to full article (OR 3.07, 95% CI 1.08–8.70, p = 0.03). Of all articles, 87% (n = 546) were accessible in full text from Cambodia. Conclusions: Scientific publications do not fully match with health priorities. Gaps remain regarding NCD, implementation studies, and health system research. A health research agenda would help align research with health priorities. We recommend 1) that the health authorities create an online repository of research findings with abstracts in the local language; 2) that academics emphasize the importance of research in their university teaching; and 3) that the researcher teams involve local researchers and that they systematically provide a translation of their abstracts upon submission to a journal. We conclude that building the bridge between research and public health requires a willful, comprehensive strategy rather than relying solely only publications. Keywords: Health, Health system strengthening, Public health, Research, Knowledge translation, Developing countries, LMICs, Non-communicable disease, Asia, Cambodia * Correspondence: [email protected] 1Epidemiology and Public Health Unit, Institut Pasteur, Phnom Penh, Cambodia Full list of author information is available at the end of the article © 2015 Goyet et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Goyet et al. Implementation Science (2015) 10:32 Page 2 of 12 Introduction (NIPH), University of Health Sciences (UHS), Pasteur The gap between research and public health priorities is Institute in Cambodia…) and some other actors (inter- a challenge for researchers and policymakers worldwide national researchers collaborating with hospitals, non- [1-3]. This gap is especially wide in developing countries governmental organizations). There is neither a systematic where evidence-based information is scarce [4,5]. Al- description of the health research output in Cambodia nor though the number of new scientific articles published an assessment of its potential for guiding public health worldwide each year is considerable, a limited proportion policymaking. of these articles report studies from low- and middle- The aim of this study was to perform a systematic re- income countries (LMICs), where most preventable view of the literature about health research in Cambodia deaths occur [6]. In 2000, the total share of publications published in peer-reviewed scientific journals from 2000 coming from LMICs was estimated at 1.7%. This shows to 2012. This careful, collaborative analysis of publica- an impressive imbalance between developed and devel- tions by national and international teams was conducted oping countries, although recent trends suggest that sci- to serve as a baseline to measure progress in developing entific production is rising in countries in transition such research capacity and harmonizing research with public as China, India, and Brazil [7-9]. heath priorities. The review therefore had dual objectives Bridging the gap between research and policymaking of (1) describing the articles published health-related requires knowledge translation (KT) strategies. KT is issues in Cambodia and (2) assessing their potential for defined as “the use of knowledge in practice and guiding health policymaking. decision-making by the public, patients, healthcare professionals, managers, and policymakers” [10]. KT is Method a non-linear process based on iterative steps [11], the Searching, retrieving, and selecting the literature first essential step being the generation, synthesis, and In October 2012, we searched the Medline database sharing of scientific knowledge produced by research. via the PubMed search engine following a search strat- Indeed, policymakers need to access studies with high egy using the keywords “Cambodia” or “Cambodian” level of evidence, using data reflecting the current burden (Additional file 1). The timeframe was from 2000 up of disease of anticipated threats, in journals accessible eas- to and including the date of the search. Since most ily and in a timely manner to help base their public health Cambodian physicians were, until recently, taught in decisions on evidence. Policymakers also need clear state- French at university, we complemented this search by ments of research findings and implications for practice performing a French-language search of the Directory [12,13]. The World Health Organization (WHO) recom- of Open Access Journals (DOAJ) and scientific jour- mends the use of policy briefs and actionable messages to nals on tropical medicine in January 2013. prompt effective communication of research findings to Eligible articles were 1) related to research conducted the most appropriate target audiences [14,15]. Actionable in Cambodia and 2) related to human health or the messages are action-oriented recommendations specifying health system in Cambodia. We excluded articles solely the actor and/or the target. To our knowledge, there is no presenting research findings on pure botany, chemistry, standardized tool to assess the presence of actionable mes- physics, or zoology. sages in publications on evidence-informed policymaking. Cambodia, a Southeast Asian LIC, is currently experi- Data extraction and management encing the multiple and complex demographic and epi- Article identifiers were downloaded from the sources demiologic changes that are associated with countries in (year of publication, journal, name of authors, name and transition [16]. Cambodia’s demographic transition began country of first author’s institution). All eligible abstracts in the mid-2000s with a rapid decrease in the birth rate were downloaded. The information on articles’ topics, and increases in population aging and rural-to-urban mi- type of research, type of data, level of evidence and con- gration. The decade 2000–2010 also witnessed an epi- tent, were independently extracted from the abstracts by demiological transition characterized by a shift from two researchers using a standardized form which was infectious to non-communicable diseases (NCD) and a pilot-tested on 200 abstracts and refined accordingly. neglected epidemic of road injuries, both of which have Discrepancies between the two researchers were system- challenged the national health system [17,18]. In this rap- atically explored, and a consensual decision was reached idly evolving but fragile context, addressing the gap in all cases after team discussions. Data were entered between research and policymaking is crucial when seek- into an in-house EpiData database format. ing to use an evidence-based approach to define the public health priority strategies. Definitions and classifications In Cambodia, health research remains limited to a few To describe the articles, the following definitions and national institutions (National Institute of Public Health methods were used: Goyet et al. Implementation Science (2015) 10:32 Page 3 of 12 The main topic of articles was classified as “diseases/ GBDS data was not available for Cambodia, the 2004 conditions” or “health system” or both. Subtopics of arti- Study was used. cles related to disease/condition issues were classified Abstracts were screened in search of recommendations according to the Global Burden of Disease Study [19]. to policymakers,